How To Get Tested
Samples used for PSA testing are collected by trained health care professionals at hospitals, labs, and other medical settings. Before getting tested, its best to talk to your doctor about the risks and benefits of PSA testing. You may be able to schedule your own PSA test at a clinic or laboratory without a doctors order. However, you will need a doctor to interpret the results of your test and recommend next steps.
Understanding Psa Test Results
28 August 2020
Medicare data suggests that up to 21% of Australian men aged 4574 choose to have a Prostate Specific Antigen Test each year, and about 19% of men aged over 74 also undergo testing.
While PSA testing helps to identify men with an increased risk of undiagnosed prostate cancer, and can help to diagnose prostate cancers earlier, it can also produce false positive results, and in some men picks up cancers that are so slow growing that they do not affect a mans life expectancy, a finding known as over-diagnosis. False positives and over-diagnosis can cause harm, which means men and their doctors need to carefully consider the pros and cons of testing, based on each mans age and other individual characteristics.
For men with no family history of prostate cancer and no symptoms, the current guidelines recommend that men who decide to undergo regular testing should be offered PSA testing every two years from age 50 to 69.
For men with a family history of prostate cancer who decide to undergo testing, the guidelines recommend men be offered PSA testing every two years from age 40/45 to 69, with the starting age depending on the strength of their family history.
Learn more here >
What is PSA?
Prostate Specific Antigen is a protein made in the prostate gland. The prostate is a walnut-sized gland that sits below the bladder in front of the rectum. It surrounds the urethra, the passage in the penis through which urine and semen pass.
Screenings Can Lead To High Costs
The cost for a PSA test is fairly lowabout $40.
If your result is abnormal, the costs start adding up. Your doctor will usually refer you to a urologist for a biopsy. Costs may include:
- A consultation fee .
- An ultrasound fee .
- Additional professional fees .
- Biopsy fees .
If the biopsy causes problems, there are more costs. You might also have hospital costs.
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Does My Psa Level Determine Whether I Have Prostate Cancer
Your provider looks at two factors related to your PSA:
- Your PSA level: A higher level means a higher risk of prostate cancer.
- A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.
But the PSA level alone doesnt determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that arent cancer.
The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
What Do The Results Mean
High PSA levels can mean cancer or a noncancerous condition such as a prostate infection, which can be treated with antibiotics. If your PSA levels are higher than normal, your health care provider will probably order more tests, including:
- A rectal exam. For this test, your health care provider will insert a gloved finger into your rectum to feel your prostate.
- A biopsy. This is a minor surgical procedure, where a provider will take a small sample of prostate cells for testing.
If you have questions about your results, talk to your health care provider.
Learn more about laboratory tests, reference ranges, and understanding results.
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The prostate is a walnut-sized gland found between the bladder and the rectum in males. Its primary job is to produce seminal fluid. The prostate creates a protein, the prostate-specific antigen, or PSA. A PSA screening test is a blood test approved by the FDA in 1994 to measure the levels of PSA in a mans blood.
Small amounts of PSA ordinarily circulate in the bloodstream and can be measured by a PSA test to monitor the health of the prostate. This test is intended to screen for prostate cancer, find other prostate-related conditions, or monitor PSA levels in those in treatment for prostate cancer. This is a simple blood test which reports PSA levels as nanograms of PSA per milliliter of blood.
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Average Psa Test Doubling Time
Another red flag. This calculation denotes the time it takes your PSA values to double.
Therefore it may signify the aggressiveness of any prostate abnormalities, whether it’s an enlarged prostate, prostatitis, or prostate cancer.
If your average PSA readings double in less than three years your doctor will most likely order a biopsy, to look in to the problem further and discuss possible prostate cancer treatment options.
High Blood Pressure And Prostate Cancer Are You At Risk
It has long been understood that there is a direct causal link between high blood pressure and a number of chronic health disorders. The links between hypertension and heart disease are particularly well documented. But recent studies in Europe and the United States are revealing that there is a surprising connection between long term high blood pressure and the development of certain cancers. These studies have specifically linked high blood pressure with an increased risk for prostate cancer in men. Even more disturbing, is the apparent link between high blood pressure and mortality rates in men diagnosed with prostate cancer.
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High Levels Of Two Hormones In The Blood Raise Prostate Cancer Risk
Men with higher levels of ‘free’ testosterone and a growth hormone in their blood are more likely to be diagnosed with prostate cancer, according to research presented at the 2019 NCRI Cancer Conference.
Other factors such as older age, ethnicity and a family history of the disease are already known to increase a man’s risk of developing prostate cancer.
However, the new study of more than 200,000 men is one of the first to show strong evidence of two factors that could possibly be modified to reduce prostate cancer risk.
The research was led by Dr. Ruth Travis, an Associate Professor, and Ellie Watts, a Research Fellow, both based at the Nuffield Department of Population Health, University of Oxford, UK. Dr. Travis said: “Prostate cancer is the second most commonly diagnosed cancer in men worldwide after lung cancer and a leading cause of cancer death. But there is no evidence-based advice that we can give to men to reduce their risk.
“We were interested in studying the levels of two hormones circulating in the blood because previous research suggests they could be linked with prostate cancer and because these are factors that could potentially be altered in an attempt to reduce prostate cancer risk.”
The researchers studied 200,452 men who are part of the UK Biobank project. All were free of cancer when they joined the study and were not taking any hormone therapy.
Mayo Clinic Q And A: Prostate Biopsies And Elevated Psa
DEAR MAYO CLINIC: I recently had a physical, which included a check of my PSA level. The doctor said my PSA level is elevated, as it has been in the past. I have undergone several biopsies that have not shown cancer. Do I need to continue with biopsies every year?
ANSWER: It may not be necessary for you to continue with annual prostate biopsies. But that depends in part on the overall level and rate of change of your prostate-specific antigen, or PSA, over time. Along with information about your PSA, your health care provider can use several other tools to determine if you need additional biopsies or if you can be monitored safely without further biopsies.
The PSA test measures the amount of prostate-specific antigen in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate a small gland that sits below a man’s bladder.
When PSA is found to be above normal levels, a prostate biopsy may be recommended to check for cancer. Biopsies involve using a needle to collect several tissue samples from the prostate gland. Then the samples are examined in a lab to see if they contain cancer.
Although the PSA test is used primarily to screen for prostate cancer, other medical conditions can cause PSA levels to rise, as well. One of the most common is benign prostatic hyperplasia, or BPH. Basically, this condition is enlargement of the prostate gland that doesn’t involve cancer. Benign prostatic hyperplasia is common as men get older.
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Cholesterol And Psa Levels
A few studies in men found that, after beginning statin therapy to lower LDL cholesterol levels, PSA levels decreased by between 4 and 40%. One study suggested that for every 10% decrease in cholesterol brought about by statins, PSA levels dropped by about 1.6 ng/mL. This relationship appears to be most noted in white men, but not black men. In white men, increased serum prostate serum antigen was associated with increased total cholesterol levels and LDL cholesterol levels. However, studies have not established a relationship between PSA and HDL cholesterol or triglyceride levels.
How Is Prostate Cancer Treated
Treatment options for prostate cancer include:
- Surgery to remove the prostate .
- High intensity focused ultrasound .
- Cryotherapy .
- Hormone treatment, also called androgen suppression therapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
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An Abnormal Psa Test: What Comes Next
If your PSA score is in the abnormal range, your doctor may recommend yourepeat the PSA test. If your levels are still high, your doctor mightrecommend one of the newer prostate cancer screening tests available today.
These tests can help better assess your risk for prostate cancer anddetermine whether a biopsy is necessary. Only a prostate biopsy candefinitively diagnose prostate cancer.
For individualized recommendations that suit you, ask your doctor about:
- What age you should start prostate cancer screening
- New blood, urine and imaging tests that are available
- Improved biopsy techniques, if applicable
White Blood Cells And Prostate Cancer
White blood cells are produced in the bone marrow and are responsible for attacking foreign agents that enter the body. White blood cells destroy invading bacteria, germs, or any substance that the body does not recognize. Depleting the number of white blood cells, which results with a low white blood cell counts, leaves the body vulnerable to infections. Because the cells of the bone marrow divide quickly, white blood cells run the risk of being destroyed by chemotherapy for prostate cancer. Chemotherapy for prostate cancer generally is not used until patients experience hormone refractory cancer or bone metastasis. Prostate cancer patients who are undergoing chemotherapy may be prone to infection in addition to their injuries taking longer to heal.
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Reasons You May Have A High Psa Level
Many factors can influence your PSA level that could result in a higher number on the blood test. Some of the most common reasons for a high PSA include:
Natural aging: Even a healthy prostate can yield higher PSA levels as you get older.
Ejaculation: Recent ejaculation can make your PSA levels go up for a period of time. If youre planning on having your PSA levels tested, your doctor will likely request that you dont ejaculate for 24-48 hours before the test.
Enlarged prostate: A non-cancerous enlargement known as benign prostate hyperplasia can raise PSA levels.
Prostatitis: An infection of the prostate gland that also increases PSA levels.
Riding a bike: Some studies indicate that riding a bicycle can put pressure on the prostate resulting in a short-term increase in PSA levels.
Hormones: Taking testosterone may also lead to a higher PSA level.
As you can see, several factors can influence your PSA levels. That is why its incredibly important that you let your doctor know about any medications, procedures, or lifestyle decisions that may influence PSA levels.
Normal Psa Levels By Age Chart
We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:
0 to 6.5
Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.
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Special Types Of Psa Tests
The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.
Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.
If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.
Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.
What Is The Test To See If I Have Elevated Psa
Healthcare providers use a blood test to measure PSA levels.
You may have a digital rectal exam together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.
Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.
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How Psa Results Are Used For Diagnosis
In the past, many doctors wanted men with elevated PSA and/or an abnormal digital rectal examination to undergo a prostate biopsy. Today, this is not a course of action recommended by the American Urological Association. In such cases, multiparametric prostate MRI is now recommended as the best front-line test to detector rule outprostate cancer.
If a mpMRI shows a suspicious finding, a MRI-guided biopsy is the most accurate way to perform a biopsy of the prostate. If this is not possible, an MRI can be used with an ultrasound-guided biopsy. This is referred to as a fusion biopsy, and is more accurate than an ultrasound biopsy alone.
What Should I Expect If Im Told I Have Elevated Psa
If your provider finds an elevated PSA level, youll have repeat tests to check your prostate. Many men with elevated PSA levels even those who have prostate cancer live long, healthy lives. Prostate cancer may not need treatment, depending on how slowly the tumor is growing. Keep up with your regular appointments and tests so your care team can keep tabs on your health.
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What Is Transrectal Ultrasound
Transrectal ultrasound is the examination of prostate using a machine called ultrasound. We insert a finger like probe into the rectum to examine the prostate. Ultrasound creates a picture of prostate using high-frequency sound waves. These sound waves come out of the probe and are transmitted through body tissues. The sound waves then bounce off the tissue and return to the probe. These returning sound waves are called echoes and are translated and recorded into photographic images. Transrectal Ultrasonography provides excellent visualization of the prostate and abnormalities that may be present in the prostate. We can also easily guide the biopsy needle under ultrasound guidance into the prostate where cancer is suspected.
The ultrasound machines in our offices are capable of doing color doppler studies and three dimensional reconstruction of the gland. Usually there is increased blood flow within the cancerous lesion or adjacent to the lesion and color doppler helps us precisely guide the biopsy needle into the lesion for accurate biopsy.
Transrectal ultrasonography is also used to estimate the prostate volume accurately to calculate PSA density.
Transrectal ultrasonography also provides images sensitive enough to defect capsular involvement and extention of cancer into the seminal vesicles .